The associations between feeding modes and diarrhoea among urban children in a newly developed country

The protective effect of breastfeeding against infantile diarrhoea may be less pronounced in areas with modern water supply and sanitation facilities. This finding raises the question whether protection by breastfeeding against infantile diarrhoea in developing countries will decline with improvement in water supply and sanitation. To address this question a historical cohort study of the associations between feeding modes and diarrhoea incidence and severity in children aged 0-14 months at baseline was done in Al Ain city, United Arab Emirates. In this city in a newly developed country, modern water supply and sanitation facilities have become available to everyone during the last two decades. During three months of follow-up of 249 children, the nonbreastfed had more diarrhoea than did the partly breastfed, who in turn had more diarrhoea than did the fully breastfed. After multivariate adjustment, this dose-response effect was consistent for three measures of diarrhoeal morbidity in each child: occurrence or non-occurrence of incidence episodes, number of episodes, and total severity score. However, significant differences were seen only between the nonbreastfed and fully breastfed subgroups. These results indicate that in Al Ain, despite the universal access to modern water supply and sanitation facilities, breastfeeding plays an important role in reducing the incidence and severity of infantile diarrhoea. This observation is particularly important given the growing concern that, as an unwanted effect of 'modernisation', breastfeeding is on the decline in Al Ain and comparable populations elsewhere.

Suppression of HIV replication in vitro by CD8+ T-cells from HIV-infected and HIV-seronegative individuals

The inhibitory effect of CD8+ T-cells from HIV-infected or HIV-seronegative individuals on HIV replication in the naturally-infected CD4+ T-cells in vitro was examined. Not only autologous CD8+ T-cells from HIV-infected individuals but also allogeneic CD8+ T-cells from HIV-seronegative individuals prevented or delayed HIV replication, even in transwell cocultures using a semi-permeable 0.45 micron filter. The level of the inhibitory effect of allogeneic CD8+ T-cells from the HIV-seronegative individuals on the HIV replication was varied among CD4+ T-cells obtained from HIV-infected individuals used. The results suggested that CD8+ T-cells from HIV-seronegative individuals as well as HIV-infected individuals could produce some cytokine(s) which suppress HIV replication in vitro. The sensitivity to the cytokine(s) might be variable among HIV strains, depending on differences in the nucleotide sequence of different HIV-1 strains. Further studies of control of HIV replication by CD8+ anti-HIV cytokine(s) should provide new strategies for the therapy of HIV infection.

5-Azacytidine (5Az) induces apoptosis in PC12 cells: a model for 5Az-induced apoptosis in developing neuronal cells

Our previous in vivo and in vitro studies showed that 5-azacytidine (5Az), a cytidine analog, induced apoptosis in developing neuronal cells in mice. To develop a system in which the precise molecular mechanism of 5Az-induced apoptosis in developing neuronal cells could be elucidated, we carried out the present study with PC12 cells. These cells are derived from a rat pheochromocytoma and extrude neurites in response to nerve growth factor (NGF). Light microscopy showed dose-dependent pyknotic and karyorrhectic changes in undifferentiated PC12 cells. Although they were less sensitive to 5Az, NGF-treated differentiated cells showed the same changes. Analysis by the TUNEL method (an in situ method for the detection of apoptosis) showed positive signals in the pyknotic and fragmented nuclei of these cells. Transmission electron microscopy revealed margination, segmentation, and condensation of nuclear chromatin, cell body shrinkage, and cytoplasmic vacuolization. Scanning electron microscopy demonstrated bleb formation on the cell surface. These pathomorphological changes are typical of apoptosis. 5Az seemed to affect cells that were in the proliferative stage; when the cells were terminally differentiated, their sensitivity to 5Az appeared to decline. PC12 cells could be used as a pathomorphological and biochemical model for studies of 5Az-induced neuronal cell apoptosis at the molecular and genetic level.

Clinical epidemiology of acute myocardial infarction in Sharjah, United Arab Emirates

Little published information about the clinical epidemiology of acute myocardial infarction (AMI) in the United Arab Emirates (UAE) is available. To fill this knowledge gap, all patients with confirmed AMI who were treated at the intensive care unit of the Kuwait Hospital, Sharjah, during 1991 were prospectively studied. This hospital, primarily for expatriate patients, provides outpatient and hospital care to expatriates for a nominal fee and to UAE citizens free of charge. It is estimated that about 80% of all expatriate AMI patients in Sharjah receive initial treatment at this hospital. Of all 153 were recorded in 30.2 (39/129), 17.8 (27/152) and 14.6% (22/151) of the patients, respectively. Overall, 73.7% (112/152) of the patients were current cigarette smokers. Of all 153 patients, 48.4, 35.9, 7.2 and 8.5% had anterior, inferior, lateral and 'other' types of AMI, respectively. Of 152 patients with available data, 15 (9.9%) died in the hospital. In a multivariate logistic regression model including all significant univariate correlates of in-hospital death (age, nationality, history of hypertension and current smoking practice) as independent variables, only being a current cigarette smoker was significantly related to a lower risk of in-hospital death in the study patients (O.R. = 0.27; 95% C.I.: 0.08-0.96). Also, UAE Arab nationality and preexisting hypertension were notable, though nonsignificant, positive correlates of in-hospital death in this model. These finding should guide future in-depth studies of the clinical epidemiology of AMI in Sharjah and elsewhere in the UAE.

Travel-Related AIDS Awareness Among Young Gulf Arab Men

Background: The Federal Ministry of Health of the United Arab Emirates (UAE) has a vigorous AIDS control programme that conforms to international guidelines. Available information on HIV infection in the Al Ain district (UAE) shows a low incidence among its citizens and a low frequency of spread by the sexual route. This is in keeping with cultural factors perceived to have withstood the potential for sexual spread in the Arabian Gulf area. However, there is an acknowledged concern for the risk to young male citizens while traveling abroad to popular destinations such as India, Thailand, and the Philippines. Methods: The authors attempted to determine the knowledge and attitude about AIDS among Emirati males (aged 18-25 years) by confidential, self-administered questionnaire (modification of a tested approach in the UK). A total sample of 298 subjects participated (94% response), comprising 47 medical students (16%), 194 nonmedical students (65%), and 57 school graduates (19%). Of all participants, 253 (85%) were unmarried. Results: Salient discriminatory findings were that medical students significantly differed from the other two groups in stating that AIDS could not be identified in a person by appearance (p=.003) and that the use of condoms was protective while traveling abroad (p<.001). The latter issue also reflected a significant difference between married and unmarried subjects, in that marital status influenced a positive response to the protective role of condoms. Among all subjects, 41% had visited Asian countries outside the Gulf region and 20% intended to visit. Conclusion: This study demonstrated a prevailing uncertainty about AIDS knowledge and a possible fear of AIDS, both of which tend to increase acceptance of special education programmes.

Apoptosis in the aged dog brain

Apoptosis similar to that seen in Alzheimer's disease patients was found in the brain of aged dogs by the TUNEL method of detecting in situ DNA fragmentation. Apoptosis was observed in both neurons and glial cells, and was morphologically characterized by round and swollen cytoplasm and aggregated nuclear chromatin, although these changes were slight. Neurons and astrocytes in the gray matter and oligodendrocytes in the white matter were affected. The number of ApopTag-positive brain cells increased slightly with age, but was not correlated to the number of senile plaques. A good correlation between the number of ApopTag-positive cells and the dementia index was clearly found. The present study indicates that brain cell apoptosis could account for dementia in aged dogs and suggested that aged dogs may be useful as a simplified animal model for Alzheimer's disease in man.

In vitro induction of apoptosis of developing brain cells by 5-azacytidine

We had found that 5-azacytidine (5Az), a cytidine analogue, could produce apoptosis of fetal developing neuronal cells on the day after injection of the agent into dams by the i.p. route at 11 days of gestation. To make a further understanding of the phenomenon by comparing the results between the in-vivo and in-vitro system, this study was carried out. Entire cephalic parts of the fetuses were collected aseptically at days 11 of gestation and a mixed culture, consisting of neuronal and mesenchymal cells, was established after one week of incubation. The silver-staining revealed pyknotic nuclei and loss of dendrites of neuronal cells in the lower (5 micrograms/ml) dose of the 5 Az-added group. SEM showed shrinkage of the cell body and blebbing formation on the cell surface. TEM evoked margination, segmentation and complete condensation of the nuclear chromatin. Scattered positive signals identical to the apoptotic cells and aggregated fragmented DNA were detected by the TUNEL method. Treatment of higher doses of 5Az (50 and 500 micrograms/ml), however, induced necrosis of both neuronal and mesenchymal cells, light- and electron-microscopically. On the contrary, the control group (0 microgram/ml) showed normal development of neuronal cells and very few positive signals of physiological apoptosis. It was concluded that 5Az could induce apoptosis of developing neuronal cells at lower doses, but necrosis of a wider cell population at higher doses. Involvement of hypomethylation, an important biochemical function of 5Az, in apoptosis was also speculated.

Diabetes, obesity and hypertension in urban and rural people of bedouin origin in the United Arab Emirates

In the United Arab Emirates, coronary heart disease has emerged as the leading cause of mortality over a 20-year period of rapid socioeconomic development. CHD risk factors of non-insulin dependent diabetes mellitus (NIDDM), obesity and hypertension were investigated by community based survey among a bedouin-derived Emirati population sample of 322 subjects (> or = 20 years). Diagnosis of diabetes was based on a random capillary blood glucose level > or = 11.1 mmol l-1. Overall diabetes prevalence was 6% (11% in male and 7% in female subjects aged 30-64 years). Urban residence was associated with higher blood glucose levels (P = 0.000), and with higher Body Mass Index (BMI) values (P = 0.002): 27% of all urban residents were obese (BMI > or = 30). The Shamsi were positively associated with higher blood glucose levels compared with other tribal groups (P = 0.000). Female gender was associated with higher BMI values (P = 0.000). Between 19 and 25% of all subjects (male or female; urban or rural residents) have systolic hypertension (> 140 mm Hg). Male gender was associated with raised diastolic BP (P = 0.023). Diabetes was associated with higher mean systolic (P = 0.0274) and diastolic (P = 0.0132) BP levels. Differences in lifestyle between urban and rural residents are becoming blurred with further socioeconomic development and it is expected that the incidence of these CHD risk factors will continue to rise. Further studies are needed to specify changes associated with urbanization. Tribal influence also merits further study given the tradition of consanguinity in the UAE and the genetic basis to NIDDM.

The timing of breastfeeding initiation and its correlates in a cohort of rural Egyptian infants

Recent data on the patterns and correlates of the timing of breastfeeding initiation in newborns are scanty for many countries including Egypt. To obtain such data in four villages in rural Bilbeis, we recruited apparently healthy, single neonates and their apparently healthy mothers within 4 days of child birth, and followed them prospectively during 1987 through 1989. All 150 neonates included in the analyses were breastfed for some duration. At the time of the first breastfeed, 36, 37, and 27 per cent of the neonates were aged < 2, 2-5, and > or = 6 hours, respectively. All neonates had received the first breastfeed by age 72 hours. In a multivariate, polytomous logistic regression model, modern birth attendants and longer ( > 8 hours) duration of labour were significantly associated with deferment of breastfeeding initiation till the neonate was aged > or = 6 hours. Breastfeeding initiation appeared to be unduly delayed in our study mothers and infants given that they were apparently healthy during the early post-partum period. Later initiation of breastfeeding was associated with indiscriminate prelacteal feeding, earlier termination of breastfeeding, and unwelcome supplementation practices. Our findings emphasize the need to initiate and/or strengthen programmes to promote appropriate breastfeeding practices in Bilbeis and other comparable areas.

The prevalence and correlates of anaemia among young children and women of childbearing age in Al Ain, United Arab Emirates

During 1992 and 1993, 309 children aged 1-22 months (mo) and their mothers visiting an immunization facility in Al Ain city, Abu Dhabi Emirate, United Arab Emirates, were studied to (1) define blood haemoglobin (Hb) levels; (2) estimate the prevalence of anaemia; (3) examine the role of iron deficiency in causing anaemia; (4) identify the correlates of anaemia prevalence; and (5) assess the acceptability to parents of an anaemia screening test for their young children. The levels of Hb in all subjects and the levels of serum ferritin in anaemic (Hb < 11 g/dl) children aged > or = 6 mo and in non-pregnant women with Hb < 11 g/dl were determined by a HemoCue Photometer and an enzyme immunoassay, respectively. Each woman was interviewed to obtain pertinent data. In children, anaemia was detected in 3% of those aged 1-2 mo (Hb < 9 g/dl), in 8% of those aged 3-5 mo (Hb < 10 g/dl), and in 25-39% of those aged > or = 6 mo (Hb < 11 g/dl). Of 19 children tested, ten (53%) were iron-depleted (serum ferritin < 12 micrograms/l). After multivariate adjustment, the only significant positive correlate of anaemia in children was older age (1-5 mo vs 6-22 mo; odds ratio [OR]: 9.51; 95% confidence interval [CI]: 3.92-23.08). Anaemia was detected in 14% of pregnant women (Hb < 11 g/dl) and 16% of non-pregnant women (Hb < 12 g/dl).(ABSTRACT TRUNCATED AT 250 WORDS)

Risk factors for development of first symptomatic Giardia infection among infants of a birth cohort in rural Egypt

Giardia infection is associated with diarrheal diseases among infants and young children in both industrialized and developing countries. A study was conducted to demonstrate the predisposing factors for occurrence of the first symptomatic Giardia infection among infants in rural Egypt. The study cohort was followed from birth through the first year of life. Univariate and multivariate analyses of data revealed that infants less than six months of age were at special risk for developing their first symptomatic infection compared with infants more than six months of age. Analysis of the data, furthermore, revealed an increased risk of infant Giardia infection associated with living in a household without a latrine (relative risk [RR] = 2.63, confidence interval [CI] = 1.4-4.9, P < 0.05), a mud floor in the sleeping rooms (RR = 1.79, CI = 1.O30-3.0, P < 0.05), and household exposure to more than 10 chickens (RR = 2.5, CI = 1.13-5.56, P < 0.05). In contrast, the mother's education beyond the primary level (RR = 0.28, CI = 0.09-0.85, P < 0.05), drinking water stored in metallic containers (RR = 0.33, CI = 0.11-0.98, P < 0.05), and male sex (RR = 0.52, CI = 0.3-0.89, P < 0.05) were associated with decreased risk of Giardia infection. These data suggest that in addition to age of infants, poverty, low education, gender discrimination, and certain environmental conditions potentiated the risk for developing the first symptomatic infection.

Apoptosis in the central nervous system of developing mouse fetuses from 5-azacytidine-administered dams

To determine the effect of 5-azacytidine (5 Az), a cytidine analogue, on the developing fetus, different strains of mice were injected with various doses of the agent, ip, at 11 days of gestation. Light microscopically, severely pyknotic cell death profiles were observed in different layers of the developing brain and spinal cord (central nervous system) on the day after the injection. Electron microscopy of the pyknotic cells revealed the shrinkage of the cell body, to various degrees margination of the nuclear chromatin, condensation of nuclear materials, fragmentation of the affected cells, and, finally, neat "bite-size" bodies engulfed by surrounding normal neuroepithelial cells and macrophage-like cells. DNA fragmentation was detected in the nuclei of the pyknotic cells by an in situ detection method for fragmented DNA ends. These changes were consistent with the criteria of apoptosis.

Behaviour disorders in primary school children in Al Ain, United Arab Emirates

A multi-stage random sample of primary school children in central Al Ain city, Abu Dhabi Emirate, United Arab Emirates was screened in January 1993 with the Rutter B2 Scale to estimate the prevalences of behaviour disorders, and to determine whether and how these were associated with the age, gender, nationality, grade and scholastic performance of the children. Of 2100 boys and girls aged between 5.4 and 16.6 years, 13.5% showed some form of behaviour disorder. The overall prevalence of disorders was significantly higher in boys than in girls (16.3% v 10.2%). Emotional, conduct and undifferentiated disorders were noted in 4.8%, 6.9% and 1.8% of all children, respectively. Conduct disorder was significantly commoner in boys than in girls (9.3% v 4.1%). In multivariate logistic regression analyses, different disorders were significantly associated with gender and/or grade and/or scholastic performance with the odds being the lowest in girls, in children in grades 3 to 6, and in children with excellent or very good scholastic performance. Nationality was not significantly associated with behaviour disorders in the children studied. A considerable proportion of young children in Al Ain manifest signs of behaviour disorders in primary school. Primary school children in Al Ain and comparable areas should be screened for behaviour disorders, and those found positive by screening tests should be assessed by health professionals to confirm the presence or absence of behaviour disorders which need expert care.

Breast-feeding in Egypt

Planning, implementation and evaluation of programmes to promote appropriate infant feeding practices require detailed, current information about these practices in the target populations. To estimate the prevalences and identify the correlates of overall breast-feeding and of exclusive breast-feeding in different age periods during infancy, a cohort of 152 apparently healthy neonates and their mothers were followed during October 1987 through April 1989 in rural Bilbeis, Sharqiya Governorate, Egypt. Feeding data were collected through twice weekly home visits thus reducing the potential for bias in our findings due to respondent recall errors. The prevalence of overall breastfeeding in the infants declined from 100% in age period 0-11 weeks to 89% in age period 36-47 weeks. Mothers with previous living children were associated with significantly higher (odds ratio [OR]: 6.53, 95% confidence interval [CI]: 1.33-32.09) and ownership of refrigerators was associated with significantly lower (OR: 0.18, 95% CI: 0.05-0.67) overall breast-feeding prevalences in age periods 24-35 and 36-47 weeks, respectively. The prevalence of exclusive breast-feeding in breast-fed infants dropped from 20% in age period 0-11 weeks to 0% in age period 36-47 weeks. After multivariate adjustment, prelacteal feeding was significantly negatively (OR: 0.12, 95% CI: 0.04-0.37) associated with exclusive breast-feeding in age period 0-11 weeks. Nearly 90% of Bilbeis infants were breast-fed at age 47 weeks, but the initiation of supplementation at 0-11 weeks in 80% of breast-fed infants is contrary to current recommendations.(ABSTRACT TRUNCATED AT 250 WORDS)

Genetic study of Japanese encephalitis viruses isolated in Malaysia

Two hundred and forty nucleotides from the pre-M gene region of 10 Japanese encephalitis (JE) virus strains isolated in Malaysia in 1992 were sequenced and compared with the other JE virus strains from different geographic areas in Asia. Our JE virus strains belong to the largest genotypic group that includes strains isolated in temperate regions such as Japan, China, and Taiwan. Our Malaysian JE virus strains differed in 32 nucleotides (13.3%) from WTP/70/22 strain isolated from Malaysia in 1970, which belonged to another distinct genotypic group.

Association between birth weight and birth arm circumference of neonates in rural Egypt

In many developing countries including Egypt, the birth weights (BWs) of most babies go unrecorded because they are born at home. Since it is difficult to record BW in the community setting, birth arm circumference (BAC) has been used as a valid proxy for BW to identify at risk babies with low birth weight (LBW). However, the validity of BAC as an indicator of the actual BW has not been assessed fully. We did this study among neonates in rural Bilbeis, Egypt, to examine the association between BW and BAC, to assess whether BAC can serve as an indicator of the actual BW, and to determine the validity indices of 3 different cut-off levels of BAC as indicators of LBW. During 1987-88, the weights and arm circumference of 148 neonates were recorded within 2 weeks of birth. We observed a strong and highly significant positive linear correlation between BW and BAC (r = 0.6188, p = 0.0001). The BAC cut-off value of < 9.5 cm was associated with the optimal combination of sensitivity (50%) and specificity (88.4%) as an indicator of LBW. In linear regression analysis BAC was found to be a significant (p = 0.00001) predictor of BW. The means of the model predicted weights for males, females, and both genders together were identical to the corresponding means of the observed values. In contingency table analysis, for 78 (52.7%) of the 148 neonates studied the observed and predicted BW categories were identical. For another 59 (39.9%) neonates, agreement with the next lower or higher BW category was observed. We feel that BAC can be used as an indicator of the actual BW in settings where routine recording of BW is currently not practicable.

Prelacteal infant feeding practices in rural Egypt

Data collected during a prospective cohort study of infant feeding and health in rural Bilbeis, Egypt, were analysed to define prelacteal infant feeding practices, identify their determinants, and assess whether these practices were predictive of breastfeeding and supplementation patterns and diarrhoea incidence during infancy. Sixty per cent (89/149) of study infants were prelacteally fed sugar-water, teas, or both. Lack of milk in the mother's breast (74 per cent), and maternal exhaustion or illness following labour (29 per cent) were the two most commonly stated reasons for prelacteal feeding. After multivariate adjustment, significantly higher incidence of prelacteal feeding was associated with childbirth during the warmer months [odds ratio (OR): 2.4; 95 per cent confidence interval (CI): 1.1-5.1], birth attendants with modern training (OR: 5.5; 95 per cent CI: 1.7-17.5), and labour lasting > 8 hours (OR: 2.3; 95 per cent CI: 0.1-4.9). Prelacteally fed infants were significantly less likely to be exclusively breastfed in age periods 0-3, 4-7, and 8-11 weeks. Diarrhoea incidence was higher among prelacteally fed infants in age periods 0-11, 12-23, and 36-47 weeks. Indiscriminate practice of prelacteal feeding and early supplementation of breastfeeding need to be discouraged.

A Bangladeshi family with three sisters 'Bombay' or Oh phenotype

Three sisters in a same family (MIAH FAMILY) are of 'Bombay' phenotype. These being the first known female examples of 'Bombay' blood group have been detected in Bangladesh. As predicted by current theory their red cells are Le(a+b-) and their saliva do not contain any of the antigens A, B and H except Lea substance. Family studies showed that individuals with 'Bombay' or Oh phenotype may have A or B gene which are not expressed. This very particular type of blood is one of the rarest in any other parts of world except in India. Due to the presence of anti-H antibody in the plasma of Oh phenotype, when considering such patients for transfusion only blood of identical Bombay type can be safely transfused.

An observational study of naturally acquired immunity to rotaviral diarrhea in a cohort of 363 Egyptian children. Calculation of risk for second episodes using age-specific person-years of observation

A cohort of 363 rural children in Bilbeis, Egypt, were followed from birth from 1981 to 1983, with twice-weekly home visits made to detect diarrheal illness. Enzyme-linked immunosorbent assay was used for detection of rotavirus in stools collected during episodes of diarrhea. Rotavirus-associated diarrhea was detected once in 74 children and twice in 12 children. Using a technique not previously described, the authors calculated the age-specific incidence rates for initial episodes and second episodes of rotavirus-associated diarrhea to estimate the effectiveness of naturally acquired immunity. Assuming that the risk of exposure was the same before and after the first episode, the observed and expected numbers of second episodes of rotaviral diarrhea were equal (age-adjusted rate ratio = 1.01; 95 percent confidence interval 0.55-1.86), given the age-specific person-years at risk. The assumption of equal risk for reexposure to rotavirus appears to be invalid, however, since the children with one and two rotavirus-positive episodes appeared to be at greater risk for diarrheal illness of all causes (rate ratios of 1.42 and 1.78, respectively). The clinical illness may have been less severe in second episodes; emesis was reported more often with first rotavirus episodes than with second rotavirus episodes, and the only fatal case was in an initial episode. These data are compatible with the existence of partial immunity, since it appears that the risk of reexposure may be greater in children who experienced rotaviral gastroenteritis earlier in life. In four of seven children, rotavirus isolates from first and second episodes were of identical serotypes, indicating that even serotype-specific immunity for rotaviral diarrhea was incomplete.